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Cutaneous Lupus Erythematosus

Spectrum of autoimmune skin conditions ranging from photosensitive malar rash and discoid scarring lesions to subacute annular plaques, with varying risk of progression to systemic lupus erythematosus depending on subtype.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dermatoloji department. Book Appointment →

What is Cutaneous Lupus Erythematosus?

Cutaneous lupus erythematosus (CLE) is a spectrum of autoimmune skin diseases mediated by interface dermatitis with damage to basal keratinocytes. Three main subtypes are recognized: acute CLE (ACLE; malar/butterfly rash, photosensitive), subacute CLE (SCLE; annular or psoriasiform plaques on sun-exposed areas), and chronic CLE (CCLE; discoid lupus, lupus profundus, chilblain lupus, lupus tumidus).

Pathogenesis involves UV-triggered apoptosis of keratinocytes, exposure of nuclear autoantigens (Ro/SSA, La/SSB), production of autoantibodies, type I interferon signaling, and complement-mediated damage. Drug-induced SCLE can be triggered by hydrochlorothiazide, terbinafine, anti-TNF agents, PPIs, and others.

Risk of progression to systemic lupus erythematosus (SLE) varies by subtype: ACLE often coexists with SLE (60-90%), SCLE (10-15% with criteria-defined SLE, often with anti-Ro/SSA), discoid lupus (5-10%, generally lower risk if isolated). Discoid lesions cause scarring alopecia, post-inflammatory dyspigmentation, and atrophy. Treatment includes strict photoprotection, topical corticosteroids/calcineurin inhibitors, intralesional triamcinolone, antimalarials (hydroxychloroquine 5 mg/kg/day with quinacrine if needed), and systemic agents (methotrexate, mycophenolate, dapsone, thalidomide, anifrolumab, JAK inhibitors).

Symptoms

Acute CLE: malar (butterfly) rash sparing nasolabial folds
Subacute CLE: annular or psoriasiform plaques on shoulders, V-neck, arms
Discoid CLE: well-defined erythematous plaques with adherent scale, follicular plugging, scarring
Discoid scalp lesions: scarring alopecia
Lupus profundus: indurated subcutaneous nodules with overlying atrophy
Photosensitivity exacerbation

Risk Factors

UV exposure (photosensitivity)
Female sex (2-3:1 in CCLE, 8:1 in SCLE/SLE)
Drug induction (SCLE: HCTZ, terbinafine, anti-TNF, PPIs)
Smoking (impairs hydroxychloroquine response)
Anti-Ro/SSA and anti-La/SSB antibodies (especially SCLE)
Genetic predisposition (HLA-DR2, DR3)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Photosensitive facial rash sparing nasolabial folds
  • Annular plaques on sun-exposed skin
  • Scarring scalp hair loss
  • Discoid scaly plaques on face, ears, scalp
  • Painful violaceous lesions on hands/feet (chilblain lupus)
  • Systemic symptoms (joint pain, fatigue) with skin findings

Treatment Methods

01
Skin biopsy with histopathology (interface dermatitis, perivascular/periadnexal lymphocytes) and direct immunofluorescence (lupus band test)
02
Serologic workup: ANA, anti-dsDNA, anti-Sm, anti-Ro/SSA, anti-La/SSB, complement (C3/C4), CBC, urinalysis
03
Strict photoprotection: SPF 50+ broad-spectrum sunscreen, protective clothing, sun avoidance
04
Topical corticosteroids (mid-high potency) and calcineurin inhibitors (tacrolimus, pimecrolimus)
05
Intralesional triamcinolone for discoid lesions
06
First-line systemic: hydroxychloroquine 5 mg/kg/day; add quinacrine if inadequate response
07
Second-line: methotrexate, mycophenolate mofetil, dapsone, thalidomide, lenalidomide
08
Refractory: belimumab, anifrolumab (type I IFN receptor antagonist), JAK inhibitors
09
Smoking cessation; avoid drug triggers; monitor for SLE progression

Which Department to Visit?

You can visit our Dermatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.